Perinatal Mental Health

June 2016: A few years ago I contributed to data analysis and co-wrote an article regarding the relationship between where women live in Canada and their risk for postpartum depression (see below). In August 2016, I will begin work on another project in the area of perinatal mental health, this time coordinating the final year of a longitudinal, National Institutes of Health-funded, multi-site (Toronto and Central/Western Massachusetts), mixed-methods study examining the postpartum mental health of visible and invisible* sexual minority women (aka the Postpartum Well-being Study). This study is lead by one of my PhD supervisors, Lori Ross (University of Toronto), and Abbie Goldberg (Clark University).

*Invisible sexual minority (ISM) women report having had female sexual partners and/or identifying with a sexual minority label (e.g., bisexual), but are currently partnered with men. Because of this they are often perceived as being “straight” or in a “straight relationship” and as a result their sexual minority identity is invisible. Who are ISM women in the Postpartum Well-being Study?

October 2016: Findings from the pilot study that informed the Postpartum Well-being Study are now published: Postpartum depression among visible and invisible sexual minority women: a pilot study. In short, pilot data suggest that women whose sexual histories include more than one gender and are currently partnered with men may be at a higher risk for postpartum depression. Early analyses of the Postpartum Well-being Study data too reveal that, compared to both visible sexual minority women and heterosexual women, ISM women report the highest rates of depressive symptoms at 6-8 weeks postpartum and during pregnancy.

Qualitative data collection for the Postpartum Well-being Study is now complete and quantitative data collection will wrap up in winter 2017. We are busy doing data analysis and writing up study findings, including papers on the sexual and relationship trajectories of ISM women, partner support, and the relationship between minority stress and postpartum outcomes. Stay tuned for more about the Postpartum Well-being Study here or visit the study website.

The relationship between place of residence and postpartum depression

Urban and rural regions along the gradient, Canada, 2001

Using data from the Canadian Maternity Experiences Survey, a national survey of Canadian women’s experiences, perceptions, knowledge and practices before conception and during pregnancy, birth and the early months of parenthood, we evaluated the relationship between place of residence (based on Statistics Canada’s framework for defining rurality) and risk of postpartum depression.

We found that Canadian women living in large urban centres are at greatest risk of postpartum depression, partly explained by increased risk for non-Canadian born women and women reporting poor social support.

ABSTRACT: Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women. Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km2), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000–499 999 inhabitants) or urban (≥ 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥ 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression. Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42–0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection. Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.

Reproductive Life Stages Program, Women’s College Hospital (assessment and short-term treatment for women experiencing anxiety and mood-related difficulties during reproductive life stages in the Toronto area)